Air Pollution in United States: 2017 Report from the American Lung Association

Air Pollution in United States: More than 4 out of 10 Breathe “Bad Air”

On April 19, 2017, the American Lung Association issued a report of air pollution in United States during 2013-2015. The “State of the Air 2017” report looked at levels of ozone and particle pollution found in official monitoring sites across the United States in 2013, 2014 and 2015. View my post on August 29, 2016, which describes the different types of air pollution.

Overall Findings The report shows that cleaning up pollution continues to be successful in much of the nation. In the 25 cities with the worst ozone and year-round particle pollution, the majority saw improvements. Many cities reached their lowest levels ever of widespread air pollution.

Worst Cities for Particle Pollution

Worst cities for air pollution in United States

Six of the ten cities with the worst air pollution in United States are in California. Bakersfield again holds the distinction of having the most days of highly polluted air.

Aerial view shows air pollution in United States - Los Angeles

Aerial view of downtown Los Angeles skyline with San Gabriel mountains in background

Key Findings  1. Despite improvements in air quality over the three years, more than 4 of 10 people breathe unhealthy levels of air pollution. 2. Air pollution increases the risk of early death, lung cancer, breathing attacks for those with asthma or COPD, and heart disease. 3. Breathing ozone irritates the lungs resulting in something like a “bad sunburn.” 4. Particles may be smaller than 1/30th of the size of a human hair. When inhaled, they are small enough to get past the body’s natural defenses. 5. People of color and those earning lower incomes are often affected by air pollution.

What Can You Do  1. Check daily air quality forecasts in your area. 2. Use less electricity. Use of electricity creates air pollution. 3. Drive less. Try to share rides and combine trips to reduce total driving. 4. Don’t burn wood or trash as these are among the major sources of particle pollution. 5. Don’t let anyone smoke indoors and support measures to make all public places tobacco free. 6. Make sure your local school system requires clean school buses.                                                                                       


Outdoor Air Pollution and COPD-related Hospital Admissions

Outdoor Air Pollution Is Associated with Increase in Emergency Department Visits and Hospital Admissions

What is Air Pollution? An air pollutant is a substance in the air that can have affect humans and the ecosystem. The substance can be solid particles, liquid droplets, or gases. A pollutant can be of natural origin or man-made.

Particulate matter coming out of smokestacks in city

Particulate matter coming out of smokestacks in city

There are three major air pollutants. 1. Particulate matter (PM) are tiny particles of solid or liquid suspended in a gas. Some particulates occur naturally, originating from volcanoes, dust storms, forest and grassland fires, living vegetation, and sea spray. Burning of fossil fuels in vehicles, power plants and various industrial processes also generate significant amounts of aerosols. 2. Nitrogen dioxide (NO2) are expelled from high temperature combustion, and are also produced during thunderstorms and by electric discharge.  They

Particulates in the air causing shades of grey and pink during sunset

Particulates in the air causing shades of grey and pink during sunset

can be seen as a brown haze dome above cities. It has a reddish-brown toxic gas has a characteristic sharp, biting odor. 3. Sulfur dioxide (SO2) is produced by volcanoes and in various industrial processes. Coal and petroleum often contain sulfur compounds, and their combustion generates sulfur dioxide. 


Study: Dr. DeVries and colleagues at Department of Work Environment, University of Massachusetts in Lowell reviewed 37 published studies to evaluate any association between short-term exposures of the three major air pollutants and COPD-related use of health care services. This included over 1 million COPD-related events. The study was published on-line in the journal COPD August 26,2016.

Results: Increases of PM, nitrogen dioxide, and sulfur dioxide were associated with 2.1% to 4.2% increases in Emergency Department visits and hospital admissions related to COPD (shortness of breath or a flare-up). Similar effects were found for each pollutant and COPD-related mortality.

Conclusions: The authors concluded that air pollution presents an on-going threat to the health of those with COPD.

My Comments: Outdoor air pollution conditions are reported daily as the Air Quality Index (AQI). Be sure to check on outdoor air pollution in your area.

  • AQI on the Internet. An AirNow Web site provides easy access to air quality information. On the web site, you will find daily AQI forecasts and real-time AQI conditions for over 300 cities across the United States, with links to more detailed state and local air quality Web sites. AIRNow’s reports are displayed as maps you can use to quickly determine if the air quality is unhealthy near you.
  • AQI via e-mail. You can sign up for a free email service using EnviroFlash ( This will alert you via e-mail when air quality is forecast to be a concern in your area.
  • AQI in the media. Many local media—television, radio, and newspapers—and some national media (The Weather Channel) provide daily air quality reports, often as part of the weather forecast.

If the air quality is “bad” in your area, stay indoors as much as possible. Wait to go shopping or do other activities when the air quality has improved.

Air Pollution and COPD Hospitalizations and Mortality

Short-term Exposure to Air Pollution Is “Bad” for COPD

Background: Air pollution is a general term for increased particulate matter in the air that we breathe. It consists of microscopic solid or liquid matter suspended in the Earth’s atmosphere. Sources of particulate matter can be man-made or natural. Overall, particulate matter can adversely affect human health.

Particulates are the worst form of air pollution due to their ability to penetrate deep into the lungs causing permanent mutations in DNA, heart attacks, and premature deaths.

If inhaled, particulate matter that is 10 micrometers or less in size (diameter) can reach the lungs.  This is abbrevaited PM10.  Even smaller size particulate matter, like PM2.5, can penetrate deeper into the small breathing tubes (airways) and reach the air sacs (alveoli).

Study: In the February 2016 issue of the journal CHEST,  Dr. Li and colleagues from Tongji University School of Medicine in Shanghai, China, analyzed a total of 18 studies that examined the short-term exposure to particulate matter in the air and COPD outcomes.  They selected studies that had measured PM2.5 in the air and COPD hospitalizations and death for 7 days after exposure in different countries throughout the world.    

Results: Short-term exposure was associated with an increase in COPD hospitalizations (+ 3.1%) and mortality (+2.5%) from 0 – 7 days after exposure.

My Comment: The authors point out that PM2.5 is more harmful to health than is PM10 because the smaller particles can be inhaled more deeply into the lungs.  Particulate matter causes oxidative stress and inflammation.  It is likely that this process caused worsening of symptoms (called an exacerbation) that led to the increases in hospitalization and death in some with COPD.

Particulate matter coming out of smokestacks in city

Particulate matter coming out of smokestacks in city

What can you do to avoid inhaling PM?  Each day check  the air quality where you live or where you are visiting.  If the air quality is “bad,” try to stay indoors if possible and use air conditioning if it hot. If you go outdoors, limit the time and wear a mask to block inhaling some of the particulate matter.

Woman wearing barrier mask

Woman wearing barrier mask to reduce inhaling particulat matter

Smoking a Chinese Water Pipe Is Worse than Cigarette Smoking

Smoking a Chinese Water Pipe is Not Safe – Increased Risk of COPD

Smoking tobacco through a water pipe is a popular activity in China, Burma, Laos, and Vietnam. Based on tradition, it has been thought that using a Chinese water pipe is safer than smoking a cigarette because tobacco smoke is filtered by the water. The Chinese water pipe has a cigarette holder along with a long and wide stem which holds the water.


This study published in the October 2014 issue of CHEST (volume 146; pages 924 – 931) surveyed 1,238 adults at least 40 years of age living in 10 towns in the Yunnan Province of China. In these areas, nearly all people who smoke a Chinese water pipe are men who usually smoke at home while the wife is exposed to passive smoking. For purposes of the study, both Chinese water pipe and cigarette smoking were defined as smoking at least 400 cigarettes per year for at least one year. The authors also analyzed the water used in the water pipes.

Man smoking a Chinese water pipe

Man in China smoking a water pipe


Both the Chinese water-pipe smokers and the cigarette smokers reported their habit for an average of 28 years.
The risks (called odds ratio) of having COPD were:
10.6 – Chinese water-pipe smokers – 56% had COPD
5.5 – Passive Chinese water-pipe smokers – 39% had COPD
3.2 – Cigarette smokers – 34% had COPD
2.5 – Passive cigarette smokers – 28% had COPD

Another risk factor for COPD in all groups was poor ventilation from stoves with chimneys. The authors reported that the water was generally “dirty” and was changed on average every 3 days by self-report. Total organic carbon of the water-pipe was 47 – 100 times greater than found in standard drinking water. Particulate matter 2.5 (microscopic solid or liquid matter suspended in the air which is commonly called air pollution) from the Chinese water pipe was twice as high as from cigarette smoke.

In summary, the study concluded that the damage to the lungs from Chinese water pipe use and exposure is worse than that from smoking cigarettes.

My Comments

This study in China shows that although water pipe smoking has traditionally been thought to safe, it is not! If you or your loved one has COPD, it is important to AVOID inhaling any irritant in the air that we breathe, such as smoke, dust, fumes, and fibers.